Reader and Industry Forum

Fitting Contact Lenses for Athletes Who Have Keratoconus

BY THUY-LAN NGUYEN, OD

Patients who have keratoconus often report symptoms of blurred vision, monocular double vision, glare, halos, and starbursts around lights. While these symptoms affect all of our keratoconus patients, they can have a more significant impact on athletes because the quality of their vision often affects their athletic performance.

It can be more challenging to fit athletes with contact lenses due to their movements and environments. There are several different contact lens modalities in both soft and GP materials that can successfully manage keratoconus. But when it comes to lens selection, a patient’s lifestyle, activity level, and individual visual needs should be taken into account. This is especially critical for active or athletic patients. I have found that scleral GP lenses can provide the necessary stability of vision, comfort, and adequate wearing time for athletes who have keratoconus.

Considerations

Most athletes who require vision correction can typically wear daily disposable contact lenses successfully. However, athletes who have keratoconus may not achieve proper acuity with daily disposable soft lenses.

There are many contact lens choices that can potentially correct a mild, early stage of keratoconus, including specialty soft lenses, corneal GP lenses, hybrid lenses, and scleral GP lenses. But when fitting athletes who have keratoconus, you need to also take into account the following extra considerations:

1. Visual Targets A lineman on the football field has very different targets compared to those of a quarterback or a receiver. Target size will also affect a patient’s motivation to wear contact lenses. For instance, if a lineman can see his opponent well enough without correction, he may not be motivated to wear contact lenses at all on the field. A quarterback or a receiver is more likely to be motivated to do whatever it takes to improve acuity.

2. Speed Fast-paced sports have very different visual requirements compared to slow-paced ones. For example, baseball players need to have more stable vision because they need to react quickly, whereas golfers have ample time to adjust before making a move.

3. Environment Vision requirements are different depending on whether patients participate in indoor or outdoor activities. Athletes often need multiple forms of vision correction, depending on the environment; this can be compared to tennis players needing different shoes depending on the type of court on which they are playing. Lighting, dust, dirt, and sweat will all affect contact lens wear.

4. Coaches and Trainers While it’s obvious that athletes who wear contact lenses need to be educated on proper contact lens handling techniques, coaches and trainers should be involved as well. Trainers, in particular, are responsible for medical supplies and also often serve as coordinators between athletes and medical professionals. Trainers should have access to spare contact lenses as well as to care solutions, saline products, and appropriate contact lens accessories for their athletes—and they should know how to use them.

Tips for Success

If you are not an expert in any specific sports yourself, how will you know what to provide to your athletic patients? Consider these tips:

1. Ask a lot of questions. Get to know your patients as individuals who have individual visual needs.

2. Get out of your examination room. Take patients out into the parking lot or, better yet, offer to meet patients in their sports environment to observe them in action. This is also an ideal way to network and attract new patients.

3. Gear up. Allow patients to bring their equipment into your office during an examination so you can learn more about their visual demands.

4. Choose the right contact lens modality. Soft torics and other speciality soft lenses for keratoconus may not give athletic patients the stability of vision needed for their sport. Many skilled athletes cannot afford to have their vision fluctuate while they are performing, and hydrogel or even silicone hydrogel materials are not conducive in many athletic environments. Traditional corneal GP lenses may pop out or get debris under them during sports and, therefore, may not be a realistic option for many athletes. Scleral GP contact lenses may offer ideal comfort, clarity of vision, stability of vision, and wearing time for many athletes, particularly those who have keratoconus or other irregular cornea conditions.

Improving Athletic Performance

While athletes who have standard refractive errors have multiple options in contact lenses, athletes who have keratoconus present with unique challenges. Even if their ocular findings are not complex or advanced, their contact lens choices are more limited. By getting to know your patients individually, you can determine which contact lenses are most appropriate for them. By asking the right questions and getting to know them on a personal level, you can better serve their individual vision needs.

For athletes of any level, the right contact lens selection could make their sport more enjoyable for them. The right contact lens could also make the difference between getting playing time and sitting on the bench. The process can also affect athletes’ longevity in the game. Lack of treatment could make a mild case of keratoconus a disability on the field, but treatment with the right contact lenses can help athletes who have keratoconus take their game to the next level. CLS

Dr. Nguyen practices in South Florida and is an assistant professor at Nova Southeastern University. She has received lecture or authorship honoraria from Paragon Vision Sciences and Walman Optical.